Retired NFL players may be at high risk of undiagnosed, untreated coronary artery disease (CAD) that often occurs without symptoms, according to new, independent, preliminary research to be presented at the American Heart Association's Scientific Sessions 2026. The study, believed to be the first assessment of coronary plaque in retired professional football players, found that most participants had plaque in their coronary arteries, and more than 40% had blockages exceeding 50%.
The research focused on 200 retired NFL players enrolled in the GAMEFILM Registry who underwent coronary computed tomography angiography (CCTA) and Heartflow AI coronary plaque analysis (AI-CPA). The AI analysis creates a personalized, color-coded 3D model of heart arteries and measures plaque volume, type and impact on blood flow. The imaging revealed coronary plaque in 85% of former players, yet only 13% had a known CAD diagnosis prior to the scan. Forty-two percent had a blockage that narrowed at least one heart artery by more than 50%, and about 1 in 5 had blockages in multiple arteries. However, less than 10% reported chest pain or shortness of breath.
Retired linemen had more plaque and more severe blockages compared with participants who played other positions. Researchers compared total plaque volume for each participant to an age- and sex-matched group and found former linemen sat above the median for total plaque volume, while players of other positions ranked well below the median—a statistically significant difference. On average, nearly 90% of the detected plaque was soft (noncalcified), which is associated with higher disease risk than calcified plaque and cannot be detected by traditional coronary artery calcium scores.
"Nearly 9 out of 10 men in this study had plaque in their coronary arteries, 4 in 10 had a significant narrowing, and yet almost none of them experienced any symptoms," said study co-author Campbell Rogers, M.D., chief medical officer at Heartflow, Inc. "These results are consistent with the fact that 1 in 3 former NFL players dies from heart disease."
The findings carry broader implications. American Heart Association volunteer expert Michael Shapiro, M.D., MPH, FAHA, who was not involved in the study, said that being a former elite athlete does not protect you from coronary disease later in life. "Plaque can build up in the artery walls for years without affecting blood flow enough to cause symptoms," he said. "So, feeling fine does not necessarily mean the arteries are healthy." Shapiro noted that there is a message to the public: "Everyone should pay attention to risk before symptoms appear. You need to know your cholesterol, blood pressure and family history, and get treatment when it is needed."
Lead study author David Maron, M.D., noted that participants were eager to take preventive action. "When participants could see the plaque in their arteries, they wanted to act—nearly 90% of those not already taking cholesterol-lowering medications before the analysis said they were ready to start treatment," Maron said. The study's limitations include voluntary enrollment and the absence of a prospectively enrolled control group of non-athletes, so the findings may not be applicable to other athletes or the general population.
The research is considered preliminary until published as a full manuscript in a peer-reviewed scientific journal. The abstract and the Online Program Planner are available for further details. Additional resources can be found on the release link.
